The State of Mental Health in India
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hello everyone
my name is satha janan and i’m the
curator of tedx bangalore
the coronavirus has altered life as we
know it across the planet
but as you can imagine there are many
india’s living in india
and the true impact of covet 19 has been
felt differently
based on income levels age gender cost
and a whole host of other qualifiers
in today’s conversation we’re joined by
manoj chandran ceo
of white swan foundation to understand
how a billion indians are living with a
fragile critical mental
healthcare ecosystem this may be india’s
achilles heel when it comes to covet 19.
so let’s try to understand the multiple
realities playing out in india as well
as
what can we possibly do about it both at
a personal as well as a systemic level
thanks so much manoj for choosing to
join us today um
could you tell us a little bit more
about the white swan foundation what’s
it all about
thank you sartaj and thanks for the
having me here for the program
and so to begin with white swan
foundation is a not-for-profit
organization
that was created with the objective of
delivering
knowledge services for mental health and
well-being
now in mental health care what we saw
when we started
our life seven years ago was that of of
all the problems and challenges that we
have seen are evident in mental health
care
the most fundamental was lack of access
to knowledge
which was uh in many ways not empowering
people to be able to make right
decisions
when i say people people would be across
all profiles people with the problem
uh their caregivers and the bystanders
also and when they were not empowered to
make the right decisions
we said how can we do that how do we
change the whole community there
bring in about a system exchange throw
knowledge so that they know that okay
this is how i decide how
i make decision based on the profile
that i carry around mental health care
so it’s been now seven years and we have
by
created by far the largest knowledge
knowledge repository on mental health
in india and we do a lot of community
outreach programs across communities
um we’ve done that for a little bit for
mental health care workers
we’ve done a lot with college students
and we currently focus a lot on
school teachers and workplace mental
health
and the third part of our work is the
mass communications
programs because as i pointed out the
most powerful
element or stakeholder in mental health
care is a bystander
they have a view on the subject and
their view is not necessarily always
very positive and inclusive
so mass communication program of white
swan foundation is to engage the
common man the community people uh into
the fold of mental health care and get
them to
have a very different mindset and uh the
empathy around people with mental health
you are you are sensitizing
the the general public so that the the
stigma probably that they used to carry
or they inherited probably from previous
generations is
is eliminated um so with that
world view and with that position that
you’re occupying at least the indian
ecosystem what is the state of mental
health care in india today
you know we’ve been going through the
pandemic it’s it’s quite more complex
now
so what is what what would you say where
where do we stand sure
sir we’ll have to look at answering that
question from different perspectives to
begin with uh
the fact remains that there is a huge
prevalence of mental health issues so
the
data that is always thrown at us is that
one in five of us
will have a mental health issue in our
lifetime now that’s a sizable number if
you look at an indian
context it will be 300 million people
and so the
the problem is large then the on the
other hand we have this whole
narrative that the number of men
professionals in mental health care is
abysmally low
and we will we need to ramp up our
service infrastructure
now that certainly is a requirement but
that probably is not the only solution
and we can’t look at solving the problem
of mental health care by only
ramping up the of the service
infrastructure and wait for that to
happen
so uh so that’s the other perspective to
it the third more powerful according to
me
is the social context to mental health
care which is about
how much again how much are we allowing
people
with the problem to open up and seek
help and
create an environment for them which is
inclusive which is more empathic
now so are we therefore targeting to
change the social narrative
the social construct around mental
health care
now we have to look at all these three
aspects to be able to come up with
innovative solutions to the problems of
mental health care
yeah so allyship you know we’ve seen it
play out in the lgbtq community in
in pwds and lots of other spaces
how is that a for example for viewers
who don’t know and even mike is
how does allyship manifest in the mental
health space is there a
is there an organization are there uh
neighborhood communities how how does
this
great point great point so we we often
get into discussions
on this subject and this is so important
because at the root of solving any
problem in mental health care
sartaj i think it is about creating a
world where everyone is a mental health
ally
and you know the moment the reason is
because the moment i know i have a view
on mental health and i have an attitude
towards somebody who has a mental health
issue
i am a stakeholder of maintenance yeah
now am i a positive
am i carrying a positive or constructive
view there i’m a
constructive stakeholder there or an
ally there there are two
very broad very basic ingredients
required to be an ally
one is empathy and i have seen this that
empathy does not get executed if you
don’t have the right knowledge
yeah many a time and when most of the
time when i am discussing having
sessions with or
conversations with people they will say
that i have a colleague who has had a
mental health issue but i don’t know how
to approach the person
i don’t know what to speak how to
communicate to the person
so i i’m actually you know by nature
empathic
but i don’t know how to demonstrate that
empathy i need to know therefore
first is to permit yourself to say that
i want to be a mental health ally now
let me pick up the right knowledge
to say that what does it mean what is
the objective of me being an ally
or me deciding to do something for my
colleague or my family member or my
neighbor who may probably demonstrate
some emotional distress
the moment i have begun to pick up the
right knowledge white swan foundation
is just the right place because they
have i mean we have huge amount of
content and
information about being an ally about
knowing what is the objective
of your action and what is that the
person with the problem
expecting of you as an ally yeah this is
what is the
what is required yeah allyship is
sometimes uncomfortable
because you’re forced to occupy a
position where you don’t have all the
answers but you still need to be present
for the other person second it is a role
of service leadership
i think you know this this touches upon
a big topic we’ve
broadly seen that a lot of mental health
is this loss of sense of control
you feel that you are no longer in
control of your own life
your own thoughts your own situation and
that that helplessness
uh often emerges internally
um allyship is one way uh access to
mental healthcare professionals is
another way what else can people do in
this current context especially of
because we never know when we could have
another lockdown or a
situation like that is there something
people can do to regain that sense of
control
from maybe a self-care perspective yes
so uh
while we spoke until now about mental
health from
a curative perspective which means that
if there is a person who has a problem
what can be done that the person reaches
out and seeks professional help
there is certainly a preventive element
to mental health care
mental health issues and
this is extremely important i would say
from in indian perspective
and countries like india which has huge
shortfall of
professionals and service infrastructure
because if you really have to solve the
problem
we have to probably also equally focus
on not allowing the problem to become
big yeah
which is about getting people to
understand the importance of preventive
steps towards mental health care so i
think it is important for
communities at every level from a family
unit
to organizations and any other
community unit that we could pick up to
begin to have this conversation around
prioritizing mental well-being
because then you are helping people who
may be
at risk and then you are allowing people
who could potentially be allowed to say
that i’m going to encourage people
to focus on well-being leaders i have
been saying this that
leaders have an extremely important role
to
encourage mental well-being and getting
people to prioritize understand what
needs to be done about
mental well-being and mental wellness so
manoj
we spoke a lot about you know the the
impact that’s being felt by the
knowledge worker and a little bit about
what the informal economy is also
feeling
it’s not possible to scale and ramp up
our our mental health care delivery
infrastructure at least
so what’s the role of technology and all
of this how can technology
hopefully play a a scale-up factor right
in this
so that’s a great angle or perspective
we must start to look at particularly
countries like india which
cannot only rely on ramping up the
service infrastructure to solve the
problems
we need technology to be able to help us
innovate and come up with solutions
which
disrupt the way we are looking at
addressing the problems
and i feel that in mental health care
particularly in india we have not we’ve
just crashed the surface in terms of the
possibilities and potential that uh it
has uh
of course in the last two three years
there’s been a slight spurt in
the uh you know uh kind of tele
consulting or delay uh counseling that
has been happening over the internet and
a lot of people have become more
comfortable with that and which is very
good
and uh so access to professionals at
least
from that perspective has increased a
little bit so you don’t have to
now rely only on mental health
professionals in university or in your
town
you can reach out uh but
and then there are of course like from
our perspective we were talking about um
you know we are a web portal essentially
at the base of what we do
and all our content goes up on the
portal and
we’ve seen the way people reach out and
seek
knowledge and seek to find what they
need to do about mental health care
we have content in english and five
indian languages
we get fifty percent of our traffic for
an english portal and fifty percentage
for our
other five uh languages bangla and hindi
are the
largest uh kind of traffic
uh you know places such as platforms uh
so much so that
um eleven percent of our traffic comes
from bangladesh
and um and you can understand you know
and also the other data is about uh the
geography
of the top ten cities that uh give us
the traffic
only four of them are metros six of them
are non-metros
and so you can clearly see that need for
knowledge
is increasing so much on mental health
care and and the demand is
irrespective of geography they just need
that access yes
do you think do you think the fact that
technology is dehumanizing
is a bit helpful in this context because
you have this shield around you right
because
typically we’ve been growing up with the
stigma of mental health so do you think
that plays a factor in our adoption
there has been i mean yes
people have told us that it i feel more
comfortable in using technology or
technology enabled services like uh
teleconsulting or ai based uh
apps and all uh so that i don’t have to
look at the human access and i don’t
have to interact
uh physically with somebody who in front
of me you know uh i think the other
interesting part where
i think some research also has coalesced
around this is screen addiction
right yes where we’ve seen that it is
essentially the attention economy and if
people are
reliant on technology then maybe that
they’re not spending
15 plus hours a day looking at a screen
so there’s a there’s a
line once you cross that line you you’re
maybe more dependent than reliant and
this and
the things shift we’ve noticed companies
like google apple facebook
suddenly incorporate screen addiction
time spent on screen and wellness as
some parts you know of their product
offering
do you think leaders technology leaders
like microsoft and
google and apple they play an outsized
role because they
ultimately are the platform owners right
do you think there is something
interesting that might happen to engage
uh top down as well uh because it’s not
just top down in government right
sometimes it’s top down in terms of
technocratic institutions as well so
i think the problem of mental health
care is so close to us
that there is no outside role for
anybody everybody has an inside room
at an individual level in my family
i have to be extremely aware of it i
should know okay there are people like
this and all at
organizational level at uh those
organized leader
leading organization level like google
and others to say that what is that i
should do
every time i come out with an extremely
nice innovative
solution product out in the market uh so
i think
everybody has to make sure that all of
us every single person and government
for instance
agencies that mental health must be
one of the priorities uh of
all of us so you
touched upon financing right yes how
we’ve seen green bonds we’ve seen lots
of innovations happen in the social
sector to try to
tap certain types of funding what does
philanthropic or even other funding look
like
in the in the context of mental health
care
uh it’s not enough uh
it’s never enough it’s never enough but
in mental health care given the size of
the problem
given the innovation that we need to see
and uh
then then then look at the kind of money
available it’s it’s not you know
certainly
so i think and i think it is important
for
philanthropic fronts to be able to say
that
whatever i have focus on there is an
element of mental health to that
so i’m i’m not looking for only mental
health explosive funds
but let’s say some funds exist for
education now
is there a part of that education fund
which says that it is about emotional
health of my children
of the students or who i have it uh who
i am
in the geography that i am serving or
sel education or sc
educational sel education is a classic
point i mean am i really investing in
that yes
because we have a very strong uh
teachers training program
we have one day training program we’ve
done that for 750 teachers because
they are the first touch point in most
cases where a problem
in a child will come out and they will
come to know about it
it all depends of the decision of the
child or their parents
in terms of how the teacher has reacted
yeah how the teacher has really
looked at the problem and created an
environment in the classroom for that
child yeah so
can i train teachers can i look at at
risk population in the classroom
yeah and what is it so a lot of data
creation collection so so we know that
probably three to four percent of our
gdp is just allocated on broad
healthcare like that’s the whole
that’s our national allocation i’m not
really sure
how much of that would be for mental
health care as well do you think
similar uh allocations exist probably
in the philanthropic or social sector
like people are thinking about health
care
but probably two to three percent of
those funds are for for mental health
exactly no i i think one is of course
there is a need for us to have exclusive
mental health care
i mean funds for that and we will look
at innovation look at
encouraging people to come out be a
social entrepreneurship area or
even entrepreneurship area and encourage
them to come up with solutions and we
really need
very innovative nice solutions there but
i’m also saying that
we want people who have funds for other
sectors to be able to say that i think
environment for instance what is the
mental health angle to which yeah
disaster natural disasters there are
funds and all what is the material thank
you to it so
so proximate partnerships within their
funding
interests but a grandfathering or at
least involving mental health healthcare
into that
yes yes